9 Things You Need To Know About Getting Your Tubes Tied

Maybe you already have the precise number of kids you always wanted, or perhaps you've decided not to have children at all. If you're confident that making babies is not in your future, sterilization may have crossed your mind. Of the ways to permanently end your childbearing years, getting your tubes tied is the most popular: 27% of American women using contraception opt for it.

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And yet, the procedure is not always well understood. Even many women who've had it done seem to be confused about what actually happens and what it means for their reproduction abilities going forward. Here are 10 important facts you need to know. (Want to balance out your hormones and lose weight? Then check out The Hormone Reset Diet to start feeling and looking better.)

1. It's a major misnomer.

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You'll never hear an expert use the phrase "getting your tubes tied" because there's not much tying going on. The more accurate (though less colorful) way to describe this procedure is "tubal sterilization" or "tubal ligation," and there are several ways it can be done. Instead of tying your fallopian tubes up in a neat bow, your doctor will clip, suture, or otherwise close them off in order to prevent sperm from getting through. Part or all of the tubes might be cut and removed. To access your fallopian tubes, your surgeon will make a 2- to 3-centimeter incision under the belly button. Or the procedure can be done laparoscopically through a few miniscule (half-centimeter) incisions. (Too much? Here are 10 non-hormonal birth control methods.)

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A related and newer method is called Essure. This incision-free technique involves having a doctor insert a tiny coil through your vagina and into your fallopian tubes, which prompts your body to make scar tissue that blocks the tubes off within a few weeks. You may have heard about this method in the news recently, thanks to some recent concerns about side effects and complications. At the end of February 2016, the FDA instructed Essure's manufacturer, Bayer, to conduct more research into the risks of the device. The FDA also proposed changes to Essure's labeling, including a checklist doctors can use to better evaluate the risks and benefits of the device as they pertain to a certain patient. Plus, "there is a technique to placing these devices," says Alison Edelman, MD, a professor of obstetrics and gynecology at Oregon Health and Science University's School of Medicine. "There can be problems around technical placement that aren't due to the device itself."

2. It really is permanent. One reason docs are so opposed to the phrase "tube tying" is it creates the false impression that the tubes can be untied, says Nikki Zite, MD, an associate professor of obstetrics and gynecology surgery at the University of Tennessee. Many women even assume that the tubes will somehow untie themselves—without medical intervention—over time. "These women are very upset when they find out that's not the case," says Zite.

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"These procedures are generally not reversible," says Vanessa Cullins, MD, Planned Parenthood's vice president for external medical affairs. That's why some doctors are reluctant to perform them on young women, who might not anticipate that they could one day marry a new partner who wants kids or simply change their minds. If you're not 100% sure that you're done having kids, Cullins suggests choosing a long-lasting—but non-permanent—option like an IUD or an implant instead. (Here are 9 IUD facts you need to know.)

3. The risks are small, but real. Tubal ligation is fairly safe, especially if you're in overall good health, at a healthy weight, and haven't previously had surgery on that area of your body. In fact, there's less than a 1% chance of complications. That said, you're having surgery, so the risk isn't zero. "There's anesthesia, which always carries a risk, and the surgeon is going into the abdomen, so there's some risk of injuring the bladder and bowel," says Zite. (Read about Angelina Jolie's decision to have her ovaries and fallopian tubes removed.)

4. You need to do some homework.

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One of the best ways to protect against surgical slipups is to thoroughly vet doctors before choosing one to operate on you. "Ask them how many they have performed and what, if any, complications they have ever had," says Cullins. "If they have performed only five, find somebody else." You'll also want to find out how recently they have done this procedure. You want someone who says last week as opposed to last month. "If it's been a few months, they may be rusty," says Cullins.

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5. It's easiest right after a C-section.

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Yes, you can have a tubal ligation at any point. But if you're about to give birth to your last child via C-section, you can ask your doctor to do it while you're already cut open so you can avoid any additional pain or recovery time beyond what the C-section itself would require. "It's relatively easy for both the patient and provider," says Zite.

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Women having a vaginal birth can also book a tubal ligation right after a baby is born. You'll save yourself a return trip to the hospital, but you'll probably experience more pain than you would have from childbirth alone and it may take you a few extra days to recover.

6. A vasectomy is a heck of a lot easier. If you and your partner have decided that permanent sterilization is the way to go, you ought to consider having him get snipped instead. (And it could lower his prostate cancer risk.) Experts prefer vasectomy over tubal ligation for several reasons: "Vasectomy is far less risky," says Zite. "The guy's anatomy is on the outside, you aren't going into the abdomen, and there's no general anesthesia involved." Cullins agrees, noting that a vasectomy is also cheaper and even more effective at preventing pregnancy than tubal ligation is.

7. Your body will still produce eggs while you're premenopausal… Eggs, produced in the ovaries, will have nowhere to go but into the abdomen or into blocked tubes, where your body eventually breaks them down and reabsorbs them. "They're so tiny, we can't even see them with our eyes," Edelman says. "You're not filling up your tummy with eggs!"

The female anatomy is a remarkable thing—this video proves it:

8. …which means you can still get pregnant. It only takes "egg meets sperm," after all.

Female sterilization is said to be 99.5% effective in preventing pregnancy. For comparison's sake, a copper IUD clocks in at 99.2%; a hormonal implant at 99.95%; and the pill, patch, and ring at 91%, with male condoms somewhat far behind at 82%. Nothing is perfect, clearly, but your chances of getting pregnant after having your tubes tied are teeny. "Yes, there are failures of permanent methods," Edelman says. "However, the failure rate is incredibly low."

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If you do become pregnant, a major concern needs to be cleared up right away: the location of the fertilized egg. If it's in the uterus, however unbelievably, there's no immediate problem other than the fact that you may not have wanted that pregnancy. (Oh, that.) But if the fertilized egg is inside the fallopian tube, the ovary, or elsewhere, it's what's called an ectopic pregnancy. "Ectopic pregnancies can be dangerous both for the woman and the developing fetus," says Paula M. Castaño, MD, MPH, assistant attending in obstetrics and gynecology at New York Presbyterian/Columbia University Medical Center, "and are really one of the true obstetric emergencies that exist." Depending on how far along the pregnancy is, your doctor will recommend either medical or surgical abortion.

9. You might not recognize your period afterward. Sterilization blocks the fallopian tubes, plain and simple. It doesn't mess with hormones, and therefore it doesn't change anything about your period or menopause. However! That doesn't mean your period itself won't change—it just won't be sterilization's fault. Here's why: Periods can change over time naturally in duration, severity, and symptoms. When something changes, it's normal to wonder why and to look for an obvious explanation. But Edelman theorizes that period changes after sterilization are more likely related to the birth control pill you stopped taking once you were sterilized. "Hormonal contraception improves periods," she says. "It's a nice benefit we don't often recognize is happening; periods get lighter, less crampy, and when women gain a permanent method and take a hormonal method away, they're faced with periods that are a lot different."

That's why experts ask patients about the benefits they've experienced on hormonal birth control. If it's regulating weight or acne or cramps for you, you might not want to stop it, even with sterilization, Castaño says, or you might want to consider a long-term hormonal method instead.

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